Over the last decades, total health expenditures have increased
significantly (Meltzer, 2001; Folland et al., 2004). Governments in low- and
middle-income countries (LMICs) as well as in high-income countries face the
difficult challenge of ensuring that necessary interventions are accessible for
those who need them, while keeping care affordable. Since good quality health
care and new medical interventions can be expensive, the process of balancing
the goals of ensuring access to good quality health care for all citizens and
ensuring affordability of health care is a difficult one (Weale, 1998).

The need for both efficient financing and budget allocation in health care
hence is ever increasing. Economic resources being limited, the issue of how
health care can be organized in an affordable manner is at the heart of many
policy discussions. It is ultimately also scarcity that forces politicians and
policymakers alike to decide on how to organize health care, what interventions
to implement and how to finance them. This is a daunting task since setting
priorities or rationing care which encompasses “explicit and regular
attempts to define how much of which services should be provided and moving
resources between services” (Hunter, 1997), clearly are unpopular topics
among constituents. Although both LMICs and high-income countries are
confronted with issues of scarcity and affordability, the degree of scarcity
obviously differs between these countries. The main aim of this thesis is to
contribute to the understanding of the role and importance of affordability in
relation to choices in health care and to its measurement. This thesis does so
through several studies in both LMICs and high-income countries.